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Hindawi Publishing CorporationJournal of Environmental and Public HealthVolume 2013, Article ID 128376, 8 pageshttp://dx.doi.org/10.1155/2013/128376

Research ArticleA Pilot Study of Increasing Nonpurposeful Movement Breaksat Work as a Means of Reducing Prolonged Sitting

Dean Cooley and Scott Pedersen

University of Tasmania, Faculty of Education, Launceston, TAS 7248, Australia

Correspondence should be addressed to Dean Cooley; [email protected]

Received 5 November 2012; Revised 8 March 2013; Accepted 13 March 2013

Academic Editor: Li Ming Wen

Copyright © 2013 D. Cooley and S. Pedersen. This is an open access article distributed under the Creative Commons AttributionLicense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properlycited.

There is a plethora of workplace physical activity interventions designed to increase purposeful movement, yet few are designed toalleviate prolonged occupational sitting time. A pilot study was conducted to test the feasibility of a workplace e-health interventionbased on a passive approach to increase nonpurposeful movement as a means of reducing sitting time. The study was trialled in aprofessional workplace with forty-six participants (33 females and 13 males) for a period of twenty-six weeks. Participants in thefirst thirteen weeks received a passive prompt every 45 minutes on their computer screen reminding them to stand and engage innonpurposeful activity throughout their workday. After thirteen weeks, the prompt was disabled, and participants were then freeto voluntary engage the software. Results demonstrated that when employees were exposed to a passive prompt, as opposed to anactive prompt, they were five times more likely to fully adhere to completing a movement break every hour of the workday. Basedon this pilot study, we suggest that the notion that people are willing to participate in a coercive workplace e-health intervention ispromising, and there is a need for further investigation.

1. Introduction

Increasing purposeful, or voluntary, physical activity bothduring leisure and work time is advocated as a means ofreducing the risk of cardiovascular disease (CVD) [1–3]. Inresponse workplace physical activity interventions have beendesigned to increase participation in purposeful physicalactivity programs during scheduled breaks in work time [4].Yet the effectiveness of such interventions is mixed becauseof problems with sustainability and adherence [5]. Moreover,it appears that an increase in purposeful physical activitydoes not alleviate the CVD risk associated with prolongedperiods of sitting (>4 hrs) [6–11]. Changes to the built envi-ronment, such as increases in technology, have resulted inprolonged occupational sitting time in excess of 6 hours [12],with concomitant decreases in energy expenditure for desk-based workers (>300 calories/per/day) [13, 14]. Guidelinesfor increasing cardiorespiratory fitness have changed overthe years to reflect a growing understanding of the roleof dose and frequency [15]. Recent evidence suggests shortbouts of physical activity both purposeful and nonpurposeful(i.e., chores, standing up) are positively associated with

cardiorespiratory fitness [15] and may buffer against issuesof adherence to workplace health and wellbeing programs[4]. Moreover increasing nonpurposeful activity as part of anintervention may also ameliorate the health risks posed byprolonged sitting.

Research shows that short bursts of physical activity (<10minutes) result in a reduction of CVD risk factors [16, 17]. Forexample, a cross-sectional analysis of the Framingham HeartStudy Third Generation participants showed that accruingphysical activity bouts of <10 minutes resulted in favourablechanges to CVD risk [17]. There is evidence of the feasibilityof these results being transferred to workplace interventions.For example, successful interventions may include a 10-minute flexibility and strength program [18], a single 10-minute bout of physical activity [19], mixed program for 30minutes [20], or group physical activity classes [4]. Moreover,it appears that sustainability and adherence rates may besuperior to those reported for purpose-based exercise inter-ventions. In one study, average monthly attendance rangedfrom 76 to 86 percent over six months [4]. Given these resultsit would appear that short bursts of nonpurposeful activitymay be suitable for worksites interventions.

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Purposeful activities are effective in improving cardiores-piratory fitness, but increases may not ameliorate the risksassociated with prolonged sitting because the activities onlyoccur once a day [21], and the seated position needs to be reg-ularly interrupted throughout the day. A number of studieshave shown that regularly breaking a seated position results inpositive changes to glucose and lipid profiles [16], lipoproteinlipase [22], and metabolic risk [23]. Consequently, there issupport for an increase in nonpurposeful movement intodesk-based work [14, 24, 25]. One strategy for increasingnonpurposeful activity is changing the built environmentby including ergonomic equipment that affords movement[13, 14]. In one study [26] middle-aged men who were eitheroverweight or obese participated in three separate dailysitting schedules with a break of six days between each of thedays. In the first trial condition, each participant sat for fivehours with no break. In the second experiment, they walkedon a treadmill desk at a light-intensity pace for two minutesevery 20minutes, and in the third trial condition they walkedon a treadmill desk at moderate-intensity pace for 2 minutesevery 20 minutes. Results revealed that light-intensity move-ment, such as standing up and moving regularly throughoutthe workday yielded health benefits. Nonetheless, despitepromising results there is little data to suggest that installa-tion of treadmill desks will result in people changing theirprolonged sitting periods because their use reflects plannedbehaviour, and subsequently such a strategy may suffer fromthe same problems as other purposive movement interven-tions. Moreover, sitting for desk-based work reflects a habitrather than a planned behaviour, and therefore interventionsmay be better informed by theory of habits [27].

Sitting for desk-based work is a habit because it is alearned act that is automatically performed in the presence ofsituational cues [27, 28]. Initially, the decision to sit at workis likely to be under the control of constructs as describedby the theory of planned behaviour [29]. Within the work-place employees are faced with a limited choice of builtenvironment (i.e., chairs and fixed height desks), prevailingworkplace attitudes towards what is required to complete thedaily tasks, and social pressures to sit while working. Thesefactors are likely to create a perception that one has littlecontrol to execute an alternative to sitting [30]. Nonetheless,developing a new habit is more complex than substitutinga new behaviour for the existing behaviour, especially if thebehaviour is complex such as those that require multipledecisions to be made in short periods of time.

Sitting for desk-based workers is a complex behaviourbecause it typically involves more than one action. Forexample, the worker has to turn on the computer, select anappropriate chair, acquire the necessary equipment for ajob task on the desk, complete multiple tasks within shorttime frames, and decide upon the sequence of these tasks.The sequence of behaviours could be described as a habitualpattern [31], but it may contain semiautomatic responses[32, 33] or behavioural scripts [34], which require somelevel of conscious thought. Yet preexisting habits may causea breakdown of the intention-behaviour relationship byoverriding the intention to perform an alternative behaviour[27].When an individual intends to perform a new behaviour

but engages in an old behaviour it is described as a slip oraction switch and is evidence of a strong habit intrusion [35].The performance of counter-habitual goal-directed actions(e.g., standing while taking a telephone call instead of sitting)requires conscious attention to interrupt the habit. If atten-tional resources are absorbed by other tasks and the intentionto perform an alternative course of action is not capable of“over-ruling” the activation of a habitual programme [35–37],an action slip may result. For example, a desk-based workerunder a high stress load because of attending to multipletasks in a short time frame may find that when the phonerings, rather than stand as they have been instructed to doto break prolonged occupational sitting time (alternativecourse of action) they find themselves maintaining the oldhabit of sitting. The issue for interventions designed to breakprolonged sitting is how to increase the odds of peopleperforming an alternative behaviour.

Onemechanism for counteracting the effect of an existinghabit on a new habit is through the use of prompts at the pointof decision [27, 28, 38]. Prompts at points of decision includea wide range of mechanisms including signs, emails, textmessages, or telephone calls [39]. The rationale is the promptpresents a situation whereby the individual is able to reeval-uate behavioural choices [38].There is research that supportsthe efficacy of prompts to help people decide to participate inalternative health behaviour. These changes typically involvethe use of electronic prompts and reminders to encouragepeople to engage in a particular behaviour [40]. For example,one study showed that a simple message at the point ofdecision extoling the health benefits of taking the stairs overthe escalator resulted in an increase in stair use over baselinemeasures [38]. In terms of the efficacy of prompting to changeprolonged sitting one study [41] showed that participantswhoreceived a computer-based prompt significantly reduced theirsitting times compared to their counterparts who receivededucation only about the health effects associated with pro-longed sitting. Nonetheless, the effect was observed only overa 5-day period within a clinically controlled environment.

Despite the promising results for interventions to reduceprolonged sitting thus far, there are some limitations toconsider. Changes to the built environment, such as havingworkers use treadmill desks,may result in an increase inworkerrors [42]. Second, the assessment of efficacy of ergonomicposture equipment is restricted to clinical studies, with nodata available from field-based research to provide an under-standing of how such changes to the built environmentmightwork or be implemented in a workplace. Thus the applica-bility and sustainability of such equipment in workplaces tobreak prolonged sitting is unknown. Moreover, the financialcosts associated with ergonomic workplace equipment maybe prohibitive to small organisations. Finally, the efficacy ofprompts is also mixed, with numerous variables influencingtheir effectiveness [39, 43]. Further, no field studies havereported the sustainability of such an intervention to breakprolonged sitting in the workplace.

Although prompts at points of decision alert individualsabout alternative behaviours, the individual can either con-sciously or unconsciously (i.e., action slip) ignore the prompt.This is a common occurrence in other health habits such as

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seat-belt wearing [44] and cell phone use while driving a car[45]. Thus, strategies should go beyond the usual range ofeducation, rehabilitation, punishment, reward, and disincen-tive schemes to change individual attitude and belief abouthealth behaviour [32] and environmental modifications toachieve significant behavioural changes among the targetpopulation [46]. We believe that it is timely to revisit someof the notions within a communitarian model of health pro-motion [47–49], in particular the active-passive approach forindividual behaviour and preventative health interventions.Within this model when individuals voluntarily performinga preventative health action (e.g., regularly breaking sittingposture during the workday) it is considered an active pre-vention strategy.Thus, only individuals who choose to engagein the behaviour would gain the protective health benefitassociated with that of regular standing, whereas passiveprevention strategies remove some or all of the decisionmaking process from the individual (e.g., only having wateravailable in the drink machines). To assess this model weutilised a workplace e-health program that allowed us tomanipulate the delivery of passive and active prompts in aneffort to have desk-based employees engage in nonpurposefulmovements throughout the workday as a means of reducingtheir prolonged occupational sitting time.

For health interventions there are a number of benefitsin adopting a more passive approach. Health interventionsthat are passive have higher compliance levels and thereforegreater efficiencies [44, 49–53]. Of note is the use of per-suasive systems, which are computerised software systemsdesigned to change or shape attitudes or behaviours [52, 53].Noncoercive [52] and coercive [53] persuasive systems havebeen successful in changing health behaviours. Given theless than successful outcomes of purposeful physical activityinterventions in the workplace which have relied on anactive approach to preventive health [5], we hoped to learnif desk-based employees would tolerate a coercive, passive-prompting e-health intervention. We were also interested indifferences between passive-based and active-based promptsfor maintaining adherence to the health behaviour designedto increase nonpurposeful movement throughout the work-day. We hypothesised that a passive prompt, compared toan active prompt, would significantly increase the odds ofparticipants complying with seven periods of non-purposivemovement during a workday. Noncompliance to the prompt-ing conditions was defined as recording between one andsix activities per workday. This number was based on themaximumnumber of prompts that a participant could receiveduring an eight-hour shift with a one-hour lunch break.

2. Methods

2.1. Sample. Participants were randomly selected fromapproximately 460 desk-based employees to take part in afield-based, sequential intervention study within a profes-sional workplace acrossmultiple sites (Project PAUSE).Giventhe lack of previous studies to guide power analysis and thepilot nature of this study, we chose a relative wide precisionestimate of 28% with 95% confidence intervals, which indi-cated that a sample size of 50 was needed. Participants were

randomly recruited through a computerised random draw.Eligibility criteria for inclusion into the study were (a) full-time desk-based employment, (b) clear of any medical healthissues, and (c) daily desktop computer access to the internet.

In terms of the sample frame, the organisation’s full-time desk-based workers were largely composed of females(67%); so, for parsimony, we chose a 1/3 split for oursample. Four participants withdrew from the study becauseof personal reasons two days before the induction and werenot replaced, as replacements could not attend the inductionat short notice. So the study proceeded with a reduced sample(𝑁 = 46). Participants had a range of work roles includingreceptionists, forensic analysis, administrative support, callcenter, sworn duties, andmedia/community liaison. Approx-imately 80 percent of participants worked in urban-basedoffices. Workplace configurations included open plan work-sites, single offices, and shared office spaces. All participantscompleted the Exercise Stages of Change questionnaire [54],which assesses individual motivation to participate in exer-cise. Participants (females = 33, male = 13) all reported beingin one of the first three stages of exercise participation (i.e.,precontemplation (23%), contemplation (58%), or prepara-tion (19%)), with no participant indicating that they hadstarted or had been involved in a regular exercise program forthe previous six months. Before data collection participantsprovided informed consent in accordance with granted uni-versity ethics committee procedures (H10875). Demographiccharacteristics of the sample are presented in Table 1.

2.2. Procedures. All participants first attended an inductionsession to inform them about the protocol of the study. Thesequence of the session was the collection of demographicbaseline data (30 minutes), an educational session on thenegative health effects associated with prolonged sitting (15minutes), general instructions on the recommended dose ofmovement to alleviate the adverse effects of prolonged sitting(20 minutes), and an informational session on using the e-health software (30 minutes). Participants were instructedthat the length of the study would be 26 weeks and werereminded that their involvement in the study was strictlyvoluntary and they could withdraw at any time. At thecompletion of this induction session, all participants had thee-health software installed onto their computers. Participantswere not blinded to other participants’ involvement becauseof the nature of some worksites, and all attended the oneinduction session.

2.3. Intervention. The intervention was an e-health softwareprogram designed to passively prompt employees to breakprolonged sitting periods by increasing nonpurposeful work-day movement. The software has two distinct phases. Itcontains a set timed prompt that reminds employees to breaktheir sitting time by engaging in nonpurposeful movementthroughout the workday. The software provides employees achoice of 60 office-appropriate activities (i.e., walking, takingthe stairs, and retrieving the photocopies). As the aim ofthe intervention was to increase nonpurposeful movementduring the workday, participants were free to choose the


Table 1: Demographic characteristics of the sample. Values aremeans standard deviations.

Variable Before AfterAge (years)

Female 41.53 (12.1)Male 46.10 (6.3)

Height (cm)Female 164.61 (6.74)Male 176.76 (6.85)

Weight (kg)Female 71.91 (13.45) 70.87 (11.88)Male 96.31 (17.96) 95.46 (17.28)

BMIFemale 26.55 (4.36) 26.19 (3.96)Male 30.81 (5.17) 30.52 (4.90)

activity, duration, and intensity. This e-health program wastested through passive and active prompting strategies.

2.4. Passive Prompt Condition. The passive prompting con-dition was initiated during the first 13 weeks of the study.During this period, participants were exposed to a promptthat did not allow them to ignore the request to engage inthe recommended behaviour.This was achieved through twomechanisms that were occurred in the following sequence.First, a small icon appeared on the taskbar. After 45 minutesthe small icon automatically enlarged into a coloured pop-up prompt (5 cm × 3 cm) onto the bottom right hand sideof participants’ screens. The prompt contained a messagealerting participants that the movement sequence was aboutto start (Figure 1).

Second, after the prompt appeared, a countdown clockstarted, and after 60 seconds, participants’ screens were de-activated, and a cover screen appeared revealing the e-healthsoftware interface. At this point of decision, participantscould select to complete a movement activity. Participantshad freedom of choice over which activity to perform andthe frequency or duration of participation.When participantscompleted their chosen activities, theywere then prompted torecord their progress.These activities were time stamped andstored on a remote server so that we were able to calculatethe total number of logged activities for each day. Loggedactivities served as our dependent variable of compliance.Once data were recorded, the sequence terminated, and theparticipants regained access to their original computer screenat the point of deactivation.The prompt would then reinitiateafter 45 minutes.

The dependent variable was determined by calculatingthe total number of days with seven or more logged activitiesand the total number of days with one to six logged activities.We set the criteria for compliance at seven or more activitiesper day because this indicated that participants were regularlybreaking their prolonged sitting every hour as indicated bythe Australian national guidelines [55]. We excluded dayswhere no activity was logged because this may have reflected

Figure 1: Prompting message seen by participants on their com-puter screens.

that the participant was out of their office, on leave, or work-ing at other worksites with no computer. As this was a self-report measure, participants received a phone call from theresearchers once throughout the study period to remindparticipants about the necessity to accurately report theiractivities.

2.5. Active Prompted Condition. After 13 weeks of the passiveprompting condition, the researchers disabled the timedprompt for a further 13-week period. During this phase, if theparticipantswanted to engagewith the e-health software, theyneeded to do so under their own volition. Participants couldstill view the icon on their taskbar and could still use the e-health software but had to voluntarily initiate the program byclicking on the icon. Once voluntarily initiated, the sequenceremained the same as that for the passive prompting condi-tion, and the dependent variable of logged activity frequencyto determine compliance was used in the same manner.

2.6. Data Analysis. Using commercially available software[56] odds within conditions (compliance/noncompliance),odds ratio (OR), and 95 percent confidence intervals for theOR were generated using a 2 (compliance/noncompliance) ×2 (passive prompt/active prompt) contingency table. Foreach prompt condition, total number of days compliant andnoncompliant for the 26-week experimental period werecalculated and used as the frequency measure. A test of thehypothesis (OR = 1) was assessed using a chi-square statistic.

3. Results

All participants (𝑁 = 46) maintained the software ontheir desktop computers for the 26 weeks of the study andrecorded activities through the study. Participants recordeda total of 2893 days out of a possible 5980 days where atleast one activity was logged for the day across the 26-weekstudy period. Participants recorded using a wide variety ofmovement-based activities, with the most popular activitiesbeing stair climbing, walking, and chair squats. Most days ofrecorded activity (Table 2) were associated with the passiveprompted condition (𝑛 = 2321 days). Similarly, the highestnumber of activities recorded for a day by an individual was23 in the passive prompt condition compared to 16 activitiesfor the active prompt condition. For the passive prompt


Table 2: Total number of days for compliance and noncompliancein each prompt condition.

Passive prompt Active promptCompliance 1216 108Noncompliance 1104 465

condition, nine activities in a day were the most frequentcount (12%) compared to one logged activity per day for theactive condition (37%).

In terms of each prompting condition, results showedthat odds of compliance were greater in the passive condition(Odds = 1.1) compared to the active condition (Odds =0.23). In terms of comparing the two conditions, a passiveprompt improved the odds of desk-based workers complyingto participate in nonpurposeful movement every hour seventimes a day nearly five times more compared to the activecondition (OR = 4.78, 95%CI = 3.78–5.93, and 𝑃 < 0.05).Therefore, participants who were automatically remindedand forced to make a decision about moving were signifi-cantly more likely to engage in nonpurposeful physical activ-ity seven times a day compared towhen theywere left to spon-taneously stand throughout theworkday on their own accord.

4. Discussion

The first finding of this study was that the employees inour sample were willing to accept a passive-based work-place e-health intervention [48] that was predicated onthe principles of introducing nonpurposeful movement. Noparticipant withdrew from the study during the 26-weekstudy, although not all participants achieved our rigid cri-teria of full compliance by completing seven nonpurposefulmovement breaks throughout the workday. Given that CVDis a major health issue [1–3] and the widening of guidelinesfor physical activity dose and frequency [15], these resultsare encouraging. Adherence to purposeful physical activityintervention are a constant problem. One cause of low adher-ence and compliance rates is some recruits to purposeful-based physical activity interventions cannot meet the highdose and frequency rates set for increases in cardiorespiratoryfitness because of a variety of factors. Our results givean indication that people who do not exercise regularlyand are willing and capable of increasing nonpurposefulmovement activities that were associated with their work ifregularly prompted to do so. Given the number of peoplewho are not regularly participating in purposeful physicalactivity [5], CVD risk could be somewhat addressed throughworkplace physical activity interventions based on increasingcompulsory nonpurposeful movement.

Our second finding was the enhanced benefit of usinga passive prompt compared to an active prompt to achieveincrease adherence to new health behaviour. A workplacee-health intervention underpinned by a passive promptincreased compliance by nearly five times to increasingnonpurposeful movement during the workday compared towhen employees were left to their own free will to comply

with the intervention. Within the context of passive versusactive approaches to interventions [48] we believe this is thefirst field-based report of desk-based employees acceptinga coercive persuasive system within a preventative healthintervention designed to increase nonpurposeful movementat work. Given the low compliance rates for the activecondition, which occurred after the passive condition for allparticipants, it could be assumed that the new behaviourof participating in hourly nonpurposeful movement hadnot become habitual. Despite the best intentions of healthprofessionals, interventions designed to increase purposefulactivity (e.g., walking, running, and strength training) havereturned mixed results [5]. Our results provide preliminaryevidence for the use of coercive persuasive systems to ame-liorate low compliance rates may work with other healthpreventative initiatives.

Finally, the compliance results in the active condition,which followed the passive condition for all participants inour sample, highlight issues with sustainability of workplacephysical activity-based interventions. The difficulty healthprofessionals have in establishing new behaviours is welldocumented in the literature [57]. It would appear that 13weeks of exposure to a coercive prompt is insufficient time toestablish the nonpurposeful movement as a new behaviour.Sitting at work is a complex behaviour that involves manysubroutines, and thus longer periods of exposure to thepassive prompt may be needed to develop the new habitof regularly breaking sitting posture to move. Or as oth-ers have [58] argued, an insistent and obtrusive remindermight well be effective in the short run, but the effectreduces significantly over time. We would advocate thatfuture research investigates a multiple strategy approach forchanging workplace health behaviours to include changes tothe built environment, such as treadmill or standing desks,coupled with a passive prompt to encourage workers tobecome less sedentary during the workday.

Our results have several possible implications. Coerc-ing people to comply with health recommendations hasthe potential to reduce wastage of personal and monetaryresources, help improve the efficacy of health and wellbe-ing interventions, and, most importantly, potentially reducemortality andmorbidity associated with preventable diseasessuch as CVD. Yet, the palatability of using passive approachesfor individual preventative health interventions, such asincreasing physical activity levels, has yet to be fully tested byresearchers. Further, to date, despite the widespread knowl-edge of the effect of base levels of exercise (e.g., walking 30minutes per day) on health and wellbeing, health researcherslament the low adherence rates within the population torecommended dose levels yet remain largely silent andinactive in recommending and prescribing nonpurposefulmovement as an alternative or an adjunct strategy.

Nonetheless, there were several limitations to this study.This was a pilot study to test the feasibility of the e-healthsoftware and the efficacy of applying a passive persuasivesystem to a workplace e-health intervention. We did notmeasure habit strength and thus are unable to determineif participants’ nonpurposeful movement habits had fullydeveloped by the end of passive prompt condition. Hence, the


poor compliance rates during the active conditionmay reflectthat the behaviour had not become habitual. Second, in theactive condition, the small number of reports for both com-pliance and noncompliance may lead to an under-estimationand hence alter the final odds ratio calculation. Third, we areunable to establish if participants may have chosen to simplystand to break their sitting time and elected not to complete aperiod of nonpurposeful activity in either condition. Finally,the measure of compliance was based on self-report. It ispossible that participants simply became annoyed with theprompts or software and chose to record a false activityor no activity because of time and work pressure. Follow-up studies should incorporate a larger sample size and usemore direct measures of compliance, such as accelerometers,in conjunction with e-health, passive-prompting softwareprograms. Moreover, there is scope to determine the saliencyof the coercive approach with other health behaviours.

5. Conclusion

Results from this study found that desk-based workers whoreceived information about the health effects of prolongedsitting and who subsequently participated in a workplace e-health intervention based on a passive approach model hadsignificantly higher compliance levels to participate in non-purposeful movement compared to voluntary engagement inthe same program. Further research is needed to rigorouslytest the efficacy of a such an approach in terms of sustain-ability, as well as what conditions employees are willing to becoerced into changing their health behaviours while at work.We plan to conduct further studies on a larger sample of desk-based workers across multiple worksites to help understandhow health can be positively influenced within the workplacein an effort to reduce the risks associated with CVD.

Acknowledgments

This studywas partly funded through aHealthy@WorkGrantsupplied by the Tasmanian government.

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